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SITE PLAN MUST SHOW ALL PROPERTY LINES AND DIMENSIONS V <br /> ❑ Drawn to Scale: 1 square= Feet Not Drawn to Scale:Total Acres 1/2 4' <br /> I <br /> I <br /> n <br /> moi . . - . . . . . . . . . . <br /> . ... . . . . . . . . . . . . . . . . . . .. . . <br /> R i <br /> 4 . <br /> k-4/ I ) • . <br /> ,... . ) ...) <br /> I Y .-1. . <br /> 12/ <br /> I I L I <br /> � 1 <br /> II di . .71. . <br /> t <br /> .� 1pgZi� 12 0400 <br /> . L i 1,4 1 <br /> I j 1 W L � <br /> I certify that the above information is accurate to the best of my knowledge. I AM THE [1]Owner [4 Authorized Agent <br /> Name(please print): 0(:,.■ Ate( "� " 4 . My telephone number is: 6-63 93 Z. -Z6/d <br /> — <br /> eao <br /> Applicant Signature: ',HOLE • _ / FF Date: 0...--/i0//4! <br /> Applicant's Mailing Address: 2493 5 Pc Av.: City: 4ii reri--& Zip: et 2- <br /> FOR OFFICE USE ONLY <br /> PLANNING: Date: <br /> PUBLIC WORKS: <br /> BUILDING INSPECTION(Acceptable for Planning requirements only) Date: <br /> Page 4 of 5 <br /> A-33D <br /> Rev.05/2011,09/2012 <br />